Provider Demographics
NPI:1205216272
Name:EARP, REBECCA MALINDA (MASTERS OF EDUCATION)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MALINDA
Last Name:EARP
Suffix:
Gender:F
Credentials:MASTERS OF EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 450789
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74345-0789
Mailing Address - Country:US
Mailing Address - Phone:918-786-3003
Mailing Address - Fax:918-786-4651
Practice Address - Street 1:700 WEST 7TH STREET
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74345-0789
Practice Address - Country:US
Practice Address - Phone:918-786-3003
Practice Address - Fax:918-786-4651
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK145764103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool